Annual Safety Review form

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Each member of the Bingham Center research team needs to fill out this form at least annually (usually in January). Before filling out the form, team members should read the safety standard operating procedures (SOPs) for activities they undertake or plan to undertake in their work. Then they should check the box next to each SOP they have read and complete the other sections of the form. Team members must fill out the form again during the year if they read additional safety SOPs. Team members are not allowed to perform any work that involves safety risk unless they have read the associated SOPs. If team members will be doing work that involves safety risks for which no SOP exists, they should contact Seth for instructions before doing that work.

You can find our safety SOPs here: https://binghamresearch.usu.edu/team_pages/safetymain

We also have SOPs for many procedures you may routinely do in the lab or field. You can find our procedural SOPs here: https://binghamresearch.usu.edu/team_pages/std_operating_proced. Many of them also contain safety information, and you should also review them periodically if you are doing the work they describe.

Your Name *

Today's Date *

YYYY

I have read or re-read the following Safety SOPs within the past 60 days (If you feel any of the SOPs are inadequate or require changes, please let Seth know).

General lab safety

Acids

Flammable liquids

Acutely toxic chemicals

Produced water (including flammable solvents and methylene chloride)

Mercury

Compressed gases

Liquid nitrogen

Pressure and vacuum

Laboratory ovens

HPLC

Electrical and electronic work

Vehicles and fieldwork

Other:

My last laboratory safety training (initial or refresher) was on this date:

YYYY

I know how to do the following (If you can't honestly check all the boxes, please re-read SOPs or get clarification from Seth): *

Access safety data sheets for the chemicals in our labs and at our field sites

Access our chemical inventory (the database of all the chemicals we have in our labs)

Add items to and remove items from our chemical inventory

Deal with chemical waste I generate in the course of my work (if you don't ever generate any chemical waste, you can check this box in good conscience)

Required

If I am injured in my work in a minor way, I will: *

If I am experiencing an emergency at work, I will: *

If I feel unsafe or uncomfortable about any work I am doing or plan to do, I will: *

I understand the risks associated with the work I do, and I understand how to mitigate those risks and work safely. (If you answer anything other than "strongly agree," please talk to Seth after you complete this form.) *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Submit

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